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Biomedical subjects

A Goudard

Publications and source records attributed to A Goudard.

At least 19 recordsLinked to original sources
PubMed1992

[Plasma glycosylated residues demonstrated by proton NMR spectroscopy. Value in the detection of heart graft rejection].

In conjunction with biopsy and Doppler studies, we analysed by high resolution proton NMR spectroscopy the blood plasma of 22 heart transplant recipients. There was a significant variation in the glycosylated residues of proteins with the development of acute cardiac rejection. A more extensive study is underway to assess the sensitivity and specificity of this approach for the early diagnosis of acute cardiac rejection.

Acetylglucosamine↗
PubMed1991

[Surgical treatment of right-sided infective endocarditis].

Between 1980 and 1989, 8 patients (5 men, 3 women; mean age 30 years) were operated upon in our department of right-sided infective endocarditis. Six patients were heroin addicts and among these 3 were HIV positive and 2 had confirmed AIDS. The most frequently encountered microorganisms (6 cases) were staphylococci. It was decided to operate because of persistent infection and haemodynamic deterioration. The infection involved the pulmonary valve in only 1 of the 8 patients. Surgery was performed during the acute phase in 5 patients and was conservative in 6 patients, consisting of excision of the vegetations or valvulectomy combined or not with valvuloplasty. A high mortality rate (3/8 cases) was observed only among patients operated upon in the acute phase. This may be due to the underlying immunodeficiency and poor haemodynamic state of these patients. Among survivors, the long-term results were excellent, with no recurrent endocarditis and no death, and with only one subsequent operation, 4 years after the first one, for residual tricuspic valve regurgitation. This study shows that patients with right-sided infective endocarditis should be operated upon outside the acute phase of the disease and as soon as complications appear, and that surgery should preferably be conservative.

Acquired Immunodeficiency Syndrome↗
PubMed1989

[Jet intravenous injection of erythromycin lactobionate. A possible cause of the occurrence of crisis in torsade de pointe].

The authors report one case of torsade de pointe which occurred immediately after fast intravenous injection of a 1-gram dose of erythromycin lactobionate in a female patient who had undergone surgical replacement of the mitral and triscuspid valves 24 hours before. The responsibility of erythromycin was strongly suggested by the clinical data (syncope), electrocardiographic findings (electrocardiogram typical of torsade de pointe, slow rhythm and lengthened QT interval in the basal ECG) and the chronology of the sequence of intravenous injection of the antibiotic and the rhythm disorder. A literature search revealed six similar cases. Its seems that the arrythmogenic property of this drug is related to abnormally elevated serum levels following rapid administration.

Erythromycin↗
PubMed1989

[Atypical heart transplantation. Technical considerations. Apropos of a case].

A heterotopic heart transplantation was performed on a patient placed on circulatory assistance with a Biomedicus pump for ten days using a heart taken from a donor with situs inversus. In relation to this case, the authors describe the technical procedures allowing transplantation of a heart obtained from a donor with situs inversus into a heterotopic position and an orthotopic position or a normal heart in a recipient with situs inversus. Lastly, in the case of complex cardiac malformations with preservation of the lungs, they present the procedures allowing heart transplantation in cases of situs incertus, anomalies of venous return and transposition of the great vessels.

Adult↗
PubMed1989

[Clinical history and anatomic findings following the longest survival after cardiac transplantation].

The authors report the case history of the first patient in the world to have survived 18 and a half years with a heart transplant. This survival was marked by several episodes of rejection during the early years and various other incidents. The pathology encountered was primarily iatrogenic: diffuse osteoporosis sometimes limited the patient's activity. Two skin cancers and a lung cancer were diagnosed and treated. The patient died from progressive respiratory failure with pulmonary hypertension and signs of right ventricular failure. Pathological examination revealed a subnormal myocardium with a certain amount of overloading of the coronary arteries, confirmed the lung cancer and pulmonary hypertension and, most importantly, revealed the presence of nodular regenerative hepatic cirrhosis responsible for ascites during the last few months of life and a renal adenocarcinoma. These last two lesions are observed in immunosuppressed patients. The authors pay tribute to this patient who led an active and devoted life in the service of others.

Carcinoma, Bronchogenic↗
PubMed1988

[18 and one-half years' survival after cardiac graft. Clinical course and anatomical findings].

Operated upon in November, 1968, the last survivor of heart transplant recipients in those times has died on May 11, 1987, having survived 18 years and 6 months. The active life of this patient, however, was marred by episodes of graft rejection during the first post-operative years and by various incidents. It was mainly the complications of the immunosuppressive treatment that hampered his activities (osteoporosis) and provoked his death. Post-mortem examination confirmed that the heart was in good condition, found an active bronchial epithelioma and revealed iatrogenic lesions, namely adenomas, adenocarcinoma of the kidney and "regenerative" nodular hyperplasia of the liver with portal hypertension. Such lesions are observed in patients under long-term treatment with immunosuppressants. A "sleep apnoea" syndrome might have accounted for the formation of pulmonary hypertension lesions. The authors wish to pay their respects to this man who devoted himself to the service of other men.

Endomyocardial Fibrosis↗
PubMed1987

[Detection by echocardiography of a thrombus of the right cavities in acute pulmonary embolism].

Echocardiography evaluates the severity of acute pulmonary embolism from its repercussions on haemodynamics. However, many authors have reported the discovery of thrombosis in the right heart cavities of patients with acute pulmonary embolism. In order to assess the frequency of intracavitary thrombosis and to evaluate the practical problems it raises, we have systematically examined by echocardiography 84 patients hospitalized for severe, acute pulmonary embolism (mean Miller's score: 21). In this series of 39 men and 45 women (mean age 62 years), 9 thrombi were detected, i.e. an incidence of 11%. Depending on the ultrasonographic images they presented, these patients were divided into two groups: 1. Six patients with low mobility thrombi attached to the cardiac wall. All benefited from a medical treatment consisting of heparin in 4 cases and a thrombolytic drug in 2 cases. There was no clinical evidence of recurrent embolism. Echocardiography showed complete disappearance of the thrombi in 5 of these 6 patients and partial regression under heparin therapy in one. 2. Three patients with a large and mobile thrombus threatening to prolapse through the tricuspid valve during atrial systole. It seemed rational to regard such thrombi as carrying a high risk of embolism with recurrences, especially since they had formed in patients already with severe pulmonary embolism. This view was confirmed by a search in the literature which yielded a 40% death rate figure when these thrombi were associated with pulmonary embolism. This high mortality, however, can be reduced by diagnostic and therapeutic measures.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1986

Triple valve procedures: an analysis of early and late results.

This study summarizes the results in 107 patients with triple valve procedures (TVP) performed between 1972 and 1983. Forty-five patients underwent double valve replacement with tricuspid annuloplasty, and 62 simultaneous triple valve replacement. The hospital mortality was 19.6% (21 patients) and was influenced by: the preoperative functional class: 4.7% (1 of 22 patients) in class II, 13.7% (7 of 51) in class III and 37.2% (13 of 35) in class IV (p less than 0.05). the urgency of operation: 13.2% in elective operations (11 of 83 patients) and 41.6% for emergencies (10 of 24) (p less than 0.02) the type of tricuspid procedure: 15.5% for annuloplasty (7 of 45 patients), 21.1% for bioprosthetic replacement (11 of 52) and 30% for mechanical valve replacement (3 of 10) (p less than 0.05). Other factors such as patient age, right ventricular systolic pressure (RVSP) and type of myocardial protection had no significant influence. The late mortality was 9% per patient-year (18 patients, 9 of whom died in the first year), the majority related to cardiac causes. The 5-year survival rate was 53%. It appears that the survival rate is higher if the patient is in preoperative functional class II (55%), the right ventricular pressure is below 60 mmHg (67%), and if the operation is performed electively (57%). The findings suggest that surgery should continue to be offered to such patients.

Adolescent↗
PubMed1984

[Selective tricuspid annuloplasty without prosthetic support].

Two techniques of plastic surgery are currently used to treat tricuspid insufficiency: a prosthetic reductor or a continuous running suture. In the technique advocated here a double continuous suture is inserted into the tricuspid annulus, one running from the antero-septal to the antero-external commissures and the other, from the postero-septal to the antero-external commissures. When these two sutures are tied separately, the circumferences of the two parts of the annulus, which are diversely dilated, can be reduced. The authors have used this technique in 141 patients and a Carpentier's annulus in 41 patients. Perioperative mortality and 5-year survival were the same in both series, but the incidence of postoperative atrioventricular block was much lower in the first one. Another advantage of the double continuous suture technique is that foreign material is reduced to a minimum.

Follow-Up Studies↗
PubMed1984

[Mitral valve replacement with bioprosthesis in children].

Forty seven bioprostheses were used for mitral valve replacement between January 1975 and June 1980, with no operative mortality, in children under 19 years of age. This study was undertaken to evaluate the medium and longterm outcome of 43 patients followed up for at least 2 years. The late mortality was higher in children under 13 years of age (11.1% per patient/year) than in older children (3% per patient/year). The incidence of reoperation for deterioration of the bioprosthesis was 5,5% per patient/year. The actuarial longevity of bioprostheses without any complications was 48 +/- 16% at 5 years. After a review of the literature, the authors discuss their present therapeutic attitude: whenever possible, mitral valvuloplasty is the operation of choice, but when valve replacement is necessary, two criteria must be considered: the age of the patient and conditions of follow up. If medical follow-up facilities are good: mechanical prostheses are preferred in patients under 13 years of age: after puberty especially in girls, the bioprosthesis is the valve of choice. If medical follow-up facilities are poor: the valve of choice is a bioprosthesis at all ages because of the risk of thromboembolism and the relatively slow clinical aggravation in cases of bioprosthetic deterioration.

Actuarial Analysis↗